Plateform Switch

8/10/2019 Plateform Switch

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PLATEFORM SWITCH


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HISTORY

The introduction of wide-diameter dental implants in the late 1980s created a situation in

which mismatched standard-diameter abutments were used simply because of the lack of

commercial availability of components to match the wide-diameter implants.

Serendipitously, it was found that these implants exhibited less-than-expected initial

crestal bone lossthe effect of bone modeling at the crest of the alveolar bone into which

dental implants are placedduring healing. Several early clinical reports demonstrated

enhanced soft (gingiva) and hard (bone) tissue responses to these platform switched

implants, leading many implant companies to incorporate platform switching into their

implant systems even for narrower-body implants.

Baumgarten H, et al. A new implant design for crestal bone preservation: Initial

observations and case report. Pract Proceed Aesthet Dent 2005;17:735-740.

Lazzara RJ, et al. Platform switching: A new concept in implant dentistry for controlling

postoperative crestal bone levels. Int J Perio Rest Dent 2006;26:9-17


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RATIONALE

It has been observed that some degree of bone resorption occurs at the crest of bone

following implant placement. Through extensive investigation, it has been discovered that

the extent of bone resorption is related to both the texture of the surfaces of the implant

and abutment at and the morphology of the implant-abutment junction (IAJ). A number of

investigators have zeroed in on the proposed inflammatory cell infiltrate that forms a zone

around the IAJ.[4] Although not yet fully understood, the current theory of the benefit of

platform switching is related to the physical repositioning of the IAJ away from the outer

edge of the implant and the surrounding bone, thereby containing the inflammatory

infiltrate within the width of the platform switch.[3]

In line with the supposed mechanism of action, it is not merely the introduction of a

platform switch, but the magnitudeof the implant-abutment diameter mismatch, that

makes a difference. Difference in bone levels became statistically significantwhen theimplant-abutment diameter mismatch was greater than 0.8 mm, providing a 0.4 mm

circumferential width of platform switch when the center of the abutment is aligned with

and fixed to the center of the implant. [5]

Ericsson I, et al. Different types of inflammatory reactions in peri-implant soft tissues. J Clin Perio 1995;22:255-261.

Atieh MA, et al. Platform switching for marginal bone preservation around dental implants: A systematic rev iew and meta -analysis. J

Perio 2010;81:1350-1366.
http://en.wikipedia.org/wiki/Statistically_significanthttp://en.wikipedia.org/wiki/Platform_switchinghttp://en.wikipedia.org/wiki/Platform_switchinghttp://en.wikipedia.org/wiki/Platform_switchinghttp://en.wikipedia.org/wiki/Statistically_significant


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This vertical loss of bone (X in the diagram at right) diminishes the bone -to-implant

contact, contributing to a potential decrease in long-term biomechanical stability[9] and

has been well researched.[10]

Tarnow DP, et al. The effect of inter-implant distance on the height of the inter-implant

bone crest. J Perio 2000;71:546-549.


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PLATFORM SWITCHING AND THE VERTICAL

COMPONENT OF BIOLOGIC WIDTH

Because the abutment is narrower in diameter than the implant fixture, a certain amount

of the implant platform is exposed when an implant is platform switched, and this exposed

area of the platform can allow for the tissues of the biologic width -- junctional epithelium

and soft connective tissueto begin forming here, requiring less bone to be resorbed to

make room for attachment on the lateral surface of the implant fixture.[11] Platform

switching has been shown to have the potential to reduce the vertical bone resorption by

as much as 70%.[12]

Greenstein G, et al. Treatment planning implant dentistry with a 2 -mm twist drill.

Compendium 2010;31(2):2-10

Vela-Nebot X, et al. Benefits of an implant platform modification technique to reduce

crestal bone resorption. Implant Dent 2006;15:313320.


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PLATFORM SWITCHING AND THE HORIZONTAL

COMPONENT OF BIOLOGIC WIDTH

Furthermore, by platform switching implants that are 3mm apart or less or within 1.5mm of

the facial aspect of a thin buccal plate, the implant-abutment junction (IAJ) is shifted onto

the implant platform away from the peri-implant bone, mitigating the deleterious impact of

the inflammatory zone at the microgap of the implant-abutment junction on the bone,

allowing for a reduction in the horizontal extent of bone loss.[3]


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Plateform Switch